Algorithm Helps Identify Proper Surfaces for Pressure Ulcer Treatment and Prevention

Janice Beitz

Janice Beitz

Patients suffering from painful pressure ulcers — commonly known as bed sores — must have the proper support surface to lie on while immobilized. A new algorithm developed in part by a Rutgers University–Camden nursing scholar will help guide nurses and other health care providers in choosing the proper surface to meet individual patient needs.

Janice Beitz, a professor at the Rutgers School of Nursing–Camden, is part of a research team that developed the method based on clinical evidence.

“There is a considerable need to guide the decision on support surfaces,” Beitz says. “A standard mattress is not designed to prevent or treat pressure ulcers because it’s the kind of mattress you sleep on at home. There are mattresses specifically made for prevention and it’s so important to get the patient on the right surface. It’s critical to improving care.”

Pressure ulcers occur when pressure on the skin reduces blood flow to an area. Without enough blood, the skin can die and an ulcer may form.

“The fact that we move around in our sleep, can get up and walk, and shift our weight protects our skin from damage,” Beitz says. “If a person is immobilized due to surgery, paralysis, or something else, they remain lying in one area. The blood supply is decreased or cut off and the patient can get a pressure ulcer.”

A number of support surfaces have been shown to reduce pressure ulcers and facilitate wound healing, but there is insufficient evidence to guide support surface selection to match individual patient needs.

That led experts from the Wound, Ostomy and Continence Nurses Society — of which Beitz is a member — to develop a consensus-based algorithm. The work was funded by Hill-Rom, a leading worldwide manufacturer and provider of medical technologies and related services for the health care industry.

Support surfaces used to treat and prevent pressure ulcers vary and include specialized mattresses designed for pressure redistribution, friction management, and control of other factors such as moisture.

Beitz, who has also helped develop algorithms for wound assessment, wound therapy, ostomy care, and pressure ulcer prevention, says algorithms are regularly used in medical practice.

“We haven’t had that kind of guidance in wound care,” Beitz says. “In developing these algorithms, you have to be able to say, ‘do this or do that’ at certain decision points during care based on evidence gained from controlled clinical trials. This is the kind of process we need to continue to develop for the science of wound care and pressure ulcer prevention. We’re trying to get away from ritual and into the science of care.”

The algorithm has been published in the Journal of Wound, Ostomy and Continence Nursing and Beitz says a digital version may soon be in development.

A fellow of the American Academy of Nursing, Beitz oversees the state’s first graduate certificate program in wound, ostomy, and continence nursing at the Rutgers School of Nursing–Camden. She was part of a research team that developed an ostomy algorithm, a step-by-step aid that allows nurses to properly assess ostomy patients and their needs, and was also part of a team that developed an interactive online version of the algorithm for use on computers and mobile devices.

Beitz also recently published a research study on prioritizing management approaches for ostomy complications.

The Rutgers University–Camden scholar received her bachelor’s degree from La Salle University, her master’s degree from Villanova University, and her doctoral degree from Temple University. She also graduated from the Germantown Hospital School of Nursing and received her post-master’s certificate as an adult nurse practitioner from La Salle University.

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